Bridges and barriers to recovery: Clinical observations from an opiate recovery project

Clinical issues are described in opiate addicts attempting to taper off methadone maintenance, and techniques are suggested to help this patient population. The observations were generated in an experimental “Tapering Network” project, in which opiate addicts on methadone maintenance had the opportunity to receive individual and group counseling, relapse prevention training, self-help groups, and other services. Vignettes illustrate clinical problems with intimacy and social isolation, identity as a former addict, and a “post methadone syndrome” characterized by vulnerability, dramatic swings in mood, and disordered thinking for a period of up to six months after detoxification. To counteract these barriers to recovery, a program model is suggested that uses curricula available in the emerging literature on treatment of substance abuse. These techniques can provide bridges to recovery.     

A mathematical simulation of the AIDS patient and extracorporeal detoxification

A simple numerical simulation of AIDS patient detoxification by a hypothetical extracorporeal device for the removal of viruses, infected white cells, and syncytia has been designed. The mathematical model accounts for healthy blood white cells attacking and destroying the viruses, while at the same time the viruses attack and infect certain white cells. The infected white cells serve as a site for viral growth; eventually the cells lyse, releasing a large number of viruses into the blood stream. The healthy white cells and infected white cells combine to form syncytia, where the virus multiplies, and finally the syncytium ruptures releasing all the virus. This model can be used to predict concentrations over a specified period for the patient. This is a mathematical model to be used as a research and design tool only.     

A comparison of residential heroin detoxification patients and methadone maintenance patients

Interviews were conducted with 101 heroin dependent persons entering a residential drug-free detoxification unit in 1989. These self-report data were compared with those previously collected in 1985-6 from 457 methadone maintenance patients. The detoxification patients injected less frequently, used less heroin, had been physically dependent for a shorter period and were more likely to be single, unemployed and to have been charged with a criminal offence in the last 12 months. It is suggested that these findings may indicate that addicts who use more heroin are less likely to seek drug-free detoxification. The wider implication of the finding is that future surveys of injecting drug users should assume that there are significant differences between heroin users entering different modalities of treatment.     

A summary of recommendations for the management of alcohol problems: the quality assurance in the treatment of drug dependence project

This report presents outlines for approaches to intervening with excessive drinkers and problem/dependent drinkers. These recommendations are based on a meta-analysis of the treatment-outcome literature, a survey of treatment practices used in Australia and the views of a panel of experts. Recommendations for assessment, detoxification and intervention for excessive, problem and dependent drinkers are made. A number of interventions that are deemed unsuitable for use in this area, or that hold promise but require more evidence before they can be advocated for use are set out.     

贝类毒素检验及排除方法的研究进展

简要介绍了麻痹性贝类毒素、腹泻性贝类毒素、神经性贝类毒素及健忘性贝类毒素等贝类毒素的来源、性质、组成及中毒机理，并探讨了贝类毒素的检验及其排除方法。     

海洛因依赖者住院脱毒过程中的不良事件及其相关因素分析

目的:了解海洛因依赖者住院脱毒过程中出现的不良事件及其相关因素。方法:采用回顾性的方法,对630例海洛因依赖者在住院脱毒过程中出现的各种不良事件进行调查,并对相关因素进行分析。结果:不良事件的总发生率为17.6％。Logistic回归分析显示,整组不良事件患者的危险因素不明确。按不良事件的严重程度归类分组分析,其危险因素依次为:美沙酮最高剂量,血常规异常,合用抗精神病药物的种类以及目前吸食方式。结论:海洛因依赖者住院脱毒过程中不良事件较常见,它的发生既有患者自身的原因,又有医源性因素,值得重视。     

42例海洛因依赖者强制戒毒中自残行为的分析

目的：调查强制戒毒期间海洛因依赖者自残原因及提出防范措施。方法：对527例强制戒毒者在强戒期间发生的42例有自残行为就其一般资料、自残原因、自残方式等相关因素进行回顾性分析。结果：自残原因与逃避惩罚、保外就医、恶劣环境、牢头狱霸欺凌、毒瘾发作等因素密切相关。结论：防范措施应以健全规章制度、强化管理、改善生活条件、倡导以人为本的人性化管理和进行合理的治疗。     

自愿戒毒患者提前出院的影响因素分析

目的:分析影响海洛因依赖患者自愿戒毒住院时间的有关因素,并提出应对措施.方法:以自拟的问卷对未满规定疗程提前出院的自愿戒毒者在出院时分别由患者自行填写和医生做出评估.结果:患者自填排列前4位的因素是:戒毒成功,身体已无不适;难忍心理渴求;生活单调乏味缺乏自由;生意上事需亲自去操办.医生评估排列前4位的是:难忍心理渴求;戒毒成功,身体已无不适;同伙鼓动、引诱;生活单调乏味缺乏自由.结论:现行自愿戒毒体制存在较大弊端--患者自由度过大,缺乏相应的约束机制.尽快出台有关自愿戒毒的法律、法规,推广自愿戒毒、强制管理戒毒模式.     

Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts

BACKGROUND: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long-term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine). METHODS: Seventy-two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long-term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature. RESULTS: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre-existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow-up. Six patients were lost during follow-up. CONCLUSIONS: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.     

中国药物依赖自愿戒毒机构的医院文化与医学伦理建设

药物依赖自愿戒毒机构的医院文化和医学伦理建设直接关系到其职能的实施和宗旨的贯彻.以现代生命伦理学和社会伦理学为内涵的医学伦理学是指导现代药物依赖临床医疗机构文化建设的重要基础之一;其对构建具有中国特色的医院文化和禁毒工作意义重大.